Pharmacological approaches for bone health in persons with spinal cord injury

Spinal cord injury (SCI) results in rapid, marked skeletal deterioration below the level of neurological lesion. Ideally, the most effective therapeutic approach would prevent loss of bone mass and architecture shortly after paralysis. Bisphosphonates preserve bone mineral density at the hip but not at the knee, which is the anatomical site most prone to fracture in the SCI population. Denosumab has recently been reported to prevent bone loss in persons with acute SCI but should be continued for an as yet indeterminate time because discontinuation will result in rapid bone loss. Several other novel approaches to preserving bone at the time of acute SCI should be tested, as well as approaches to reverse bone loss in individuals with chronic SCI.

Automated summary

Spinal cord injury (SCI) leads to rapid and significant skeletal deterioration below the level of neurological lesion. Current therapeutic approaches such as bisphosphonates and denosumab can help preserve bone mineral density, but there is limited protection for knee bone density. Further research is needed to explore novel methods for bone preservation during acute SCI, as well as strategies to reverse bone loss in individuals with chronic SCI.